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LV t1 i {VI-4 {VLll l�f1C4[1C J <br /> File Original,DuFlicate and Triplicate with the WATERWELL DRILLERS REPORT Do Not Fill In <br /> DlfflfoR OF WATER RESOURCES (Seca"--$7076,7077,7079,W,ter cede) <br /> P•o. Boz 11179 STATE OF CALIFORNIA—DEPARTMENT OF PUBLIC WORKS Stare WWII No.____-.-_-._.-_- <br /> SACRAMENTO 5,CALIFORNIA <br /> DIVISION OF WATER RESOURCES 3 S`6 Other Well No.—/:t- <br /> R cgio n--------------------- <br /> - <br /> .1) <br /> DRILLER: (person, firm, or corporation) ------_-_--�----_------ <br /> N"'no r( 7y (s) LOCATION OF WELL: <br /> L r{T Pzm m„- nll T rl ORS_ Counry d JC <br /> Address 61x.6 SOT7TH CALIt J_R"CIA STHET R.F,D.ar Street No, e <br /> STOCKT01I7, CALIIORNIA ree -"`�"✓ `��`.� <br /> c NER: <br /> � 1�`.,:nc ''•:TI'S_ 1� .� �! r n• <br /> Address <br /> 1049 Buena Vista — <br /> tackton, Califox laid (9) WELL LOG: <br /> Total depth of wcrl <br /> it <br /> _ Formation: Mention size of nater grave€— <br /> (2) Proposed Use (Cheek) Ectuipmel, 0rr.to It, t <br /> Domestic ® Industrial 1-1 Rotary 27 ellow Clay <br /> �+ Irrigation ❑ Test Well ❑ Cable [ 27 35 Brotwn 3a_nd -- <br /> Municipal ❑ Other Dug Well ❑ 2 Blue Cle <br /> ❑ Ocher El -2 68 Gray Sand(3) CASING; 68 7,2 Blue Cl <br /> nqr. Of 8 in7.2 -€�,.,rga. ea,ing It,t i 72 •• 77 •• GrM Sancl <br /> 77 87 Blue Clev <br /> 87 91 Or460 Sand <br /> — '• 129 Blue C1,., <br /> „ <br /> 129 13GrayGr Sand <br /> Ti�pe and site of shoe or well ring 136 " 138 '• Blue Clay <br /> a., __�__�_ --.— 138 Gray 9&r_d <br /> `4) PERFORATIONS: <br /> I.ype of perforator used <br /> f Perroratrd ft. to It. —�... •• <br /> -------------- <br /> i..+ " <br /> Diameter of perforations in., length " <br /> (5) WATER LEVELS: <br /> Was electric lag made of well? [] yesro <br /> U N. li Yes,attach copy, .. � <br /> Depth at a-hick water a s first Found '} 7 <br /> +-- 27 <br /> Standing level before perforating �•1 <br /> ft. s0 c <br /> Standing level alter perforating <br /> Note your ob,cr-ors of any changern wutr Sevtl 4h;le drilling <br /> Q"asemrfaee sanitary seal provided? •' ,,,'f, s'•`"�l ta.� <br /> (6) WELL PUMPING TEST: <br /> Work acarttd —28 19 2 Complered 28 4 <br /> 1..+ Gpacity galS' 19 J <br /> It,draw dove Date of Report J'Ul <br /> .—. 3Q l9 j <br /> �ti'as well gravel paektd? WELL DRILLER'S STATEMENT: <br /> e'er:any stmt,-bed:gAin r pollution? This well was tlrilleil urulrr Nfy jifrisdirtio,r and this report it true to the be <br /> Of my knowlctlge vitt Gelirf. <br /> Temptrn ure Aruch r�y�r�y� n7t <br /> �L"as a chemical analysis made? copy <br /> [SIGNED]I(abndand wwell capptd> REP--,'.'•1Q--T---O---R-- tf <br /> ORKS <br /> ----------.------ <br /> .W,11 Drift— <br /> +•+ (7) TYPE OF WORK (check): - <br /> New well <br /> License No..._670 V r <br /> Reconditioning of welt [d - ------------------- _..Ciassifieation.._..__."J�--- _ <br /> Deepening existing well Q Diced-------------------------_----------_-------------- <br /> 46370].St"Oat-�V IN V SPO <br /> �I - <br />